1770109027 NPI number — WYNTER OSTLUND MASSAGE THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770109027 NPI number — WYNTER OSTLUND MASSAGE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYNTER OSTLUND MASSAGE THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770109027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8008 NE 159TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-869-6398
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 W MAIN ST STE 213
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE GROUND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98604-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-869-6398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OSTLUND
Authorized Official First Name:
WYNTER
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
MASSAGE PRACTITONER
Authorized Official Telephone Number:
360-869-6398

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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